The Future of Health Reform – as The Supreme Court Decision Looms.

Posted on | March 30, 2012 | 6 Comments

Mike Magee

Anyone with even a fleeting interest in Health Care Policy had eyes and ears focused on the three days of testimony earlier this week before the Supreme Court. Up for grabs is the future of the Affordable Care Act. The arguments for and against were pretty high minded – Can you say “Liberty”? – and pretty low end – Can you say “broccoli”?

As we speak, the Supreme Court is meeting behind closed doors to take its first vote, and to allow Justice Roberts to identify who will be given the responsibility to write the Majority Opinion Report. Any Justice can change opinion at any time up to the final ruling. Anyone who feels the decision to be made is an easy one is missing reality, at least on two counts.

First, rejection of this legislation reinstates the status-quo, which even the most resistant of the nation’s various health power blocks realizes is no longer an adequate fall back position. Second, over the past year, health delivery organizations, and the thousands of suppliers, designers and advisers that support them, are into their 2nd year of delivering new structures to accomodate the new law. To reverse at this moment has significant downstream cost.

On the first issue, reverting to status-quo, understand what that entails. It means accepting the loss of improvements that are visible and part of the public record including:

2010: A new Patient’s Bill of Rights goes into effect, protecting consumers from the worst abuses of the insurance industry. Cost-free preventive services begin for many Americans.
See More 2010 Changes.

2011: People with Medicare can get key preventive services for free, and also receive a50% discount on brand-name drugs in the Medicare “donut hole.”
See More 2011 Changes.

2012: Accountable Care Organization s and other programs help doctors and health care providers work together to deliver better care.
See More 2012 Changes.

2014: All Americans will have access to affordable health insurance options. New Health Insurance Exchanges will allow individuals and small businesses to compare health plans on a level playing field. Middle and low-income families will get tax credits that cover a significant portion of the cost of coverage. And the Medicaid program will be expanded to cover more low-income Americans. All together, these reforms mean that millions of people who were previously uninsured will gain coverage, thanks to the Affordable Care Act.
See More 2014 Changes.

As for issue two, consider yesterday’s message from consulting firm Mercer:

“Even as the US Supreme Court contemplates arguments heard this week on the federal health care reform law, employers are moving ahead with strategies to more effectively manage their health care spending. Mercer, a global leader in human resource consulting and related services, has developed a wide range of exchange-type offerings that are designed to help organizations of all sizes manage their employee and retiree health plans in order to reduce costs, manage risk and provide employees with quality, choice and simplicity.”

“Mercer is offering a wide variety of exchange solutions aimed at helping employers ensure they are in compliance with the US health care reform law while continuing to provide benefits that are affordable and attractive,” said Sharon Cunninghis, US leader of Mercer’s health and benefits business. “Mercer’s suite of solutions will help employers of all sizes and funding arrangements that wish to offer employees greater choice in the benefits they receive, while providing coverage in a cost-effective way.”

This is not to say that a mandate is insignificant. I have issues with it myself – mainly around the costs associated with managing and enforcing such an approach. I’d rather see clear cut tax support as we have for Medicare and Medicaid. That aside, we all need to consider the cost and pain associated with starting from scratch.

Reinforcing an old ship that is already taking on water, when so many are fast at work building a better vessel – imperfect, but at least sea worthy and capable of managing the modern currents of change – would seem unwise, and destined to cost all of us a great deal more (in pain, suffeing, and money) in the immediate future.

For Health Commentary, I’m Mike Magee

Comments

6 Responses to “The Future of Health Reform – as The Supreme Court Decision Looms.”

Mike Chase
March 30th, 2012 @ 5:30 pm

I find it sad…dis-ingenuine…and outright biased…. that Dr. MaGee has PURPOSELY left out the NEGATIVES in his commentary. Every one of the comments comes from a biased viewpoint hyping the “possible” “good” traits of the bill and actions that have taken place so far by SOME (not all) involved with the healthcare system at present. And seriously people….who cares if SOME have put $ into what “may” be the new healthcare law….instead of them being wise…and waiting to see if it even passes BEFORE doing so. Ludicrous.
Stop the hype and propaganda….admit the fact that the public (individuals) will LOSE their right to decide WHO cares for them….WHAT available treatments or methods will be used for them…. and IF any will be available to them AT ALL…. because “maybe” the “system” finds them “unworthy” of saving. GET REAL Dr. MaGee.
Mike Magee
March 31st, 2012 @ 8:43 am

Thanks. As for the “bias – I guess that’s why it’s called Health
Commentary.

.
JACK KING
April 1st, 2012 @ 12:16 pm

This is a highly biased and one-sided commentary. What has failed to be mentioned is that Billions of Dollars in new cost shifting is being pushed back onto the already financially stressed states as so-called Health Care Reform shifts costs onto Medicaid. And ss Global Pyments ramp up, Medicare and Healthplan costs (and risk) is being shifted onto the backs of doctors and hospitals. All the while, health plans are pushing families into high deductible health plans forcing families to pay full cost to get evn basic treatments and standing as a barrier to care since most families will wait to get care to avoid these costs. Obamacare has some good features which could have been implimented without 2700 pages of government overreach…unfortunately it is the disaster that many suspected from the outset…and the worst is yet to come.
Perry Boggia
April 2nd, 2012 @ 10:57 am

Dear Dr. Magee,
This is a complicated issue and I do believe balance requires you to address the core issue. Is it Constitutional? Really that is all the court should consider. I happen to think the many sections of the law that you referenced are long over due to our nation’s health care system. My congressman from Nashville TN, cast a brave vote in favor of the law, as he realized from the economic forecasters published on his web site, the current system is unsustainable economically and would increase our national debt, where as this bill showed real promise of actually reversing the sky rocket forecasts of increasing health care costs. His point – If you really care about our out of control National Debt, you must vote for this bill.

But, right now, in front of the court, none of this matters

I like many, rate our federal elected office holders at the bottom. I think polls rate congress at about a 15 percent postive on trust and performance, especially regarding the strewardship of economic resources.

So what about the bottom line. I am not a lawyer, although my three attorney siblings often had remarked, “you are the one who really should have gone into law”, I’ll leave that to my daughter, a 1st year law student at Fordham in NYC.

The central issue at question from the “Patient Protection and Affordable Care Act” , is clearly the “individual mandate” , requring all Americans to have health insurance or pay a fine. The Obama administration argued authority under the Constitution’s Commerce Clause, which grants the federal government broad power to regulate interstate trade. Opposing arguments, including 26 states, are concerned this section of the bill far exceeds Congress’s constitutional authority and would lead to unlimited Federal power.
That prospect does unnerve me.
I understand the crisis , 50 million Americans are uninsured, they show up at our hospital emergency rooms. It is estimated the treatment of these people adds an extra $1,000 to family health polices . So, why should we pay??
Hey, if people don’t eat broccoli, it doesn’t cost me a dime, but that $1000 bucks does bother me especially on a teacher’s salary. My daughter has health care because of this bill and the abuses of the heavily protected insurance companies must be stopped.

My final comment and how I hope the court rules: I hope they rule it is unconstitutional, why? Because it is!!

Justice Scalia (aside from the broccolic question), asked during the oral arguments “If the government can do this (remember our confidence factor with them – 15%) what can it not do”?

This is a much more important question for our nation and it upholds our founding fathers brilliant form of government. The court must uphold our constitution, no matter how well intended the law they are reviewing.

If not them, they who? If not now, then when? If this precedent is set, it will be too late.

I don’t offer a solution to the health care crisis, other then to say, congress should rework this section making constitutional. I am not totally politically nieve, realizing during a presidential campaign, this is unlikely and I am not sure if this section is out, will the whole act be out, but it doesn’t matter.

Congress is such a flawed organization, already brought and paid for by special interest groups on both sides and to now give them virtually unlimited powers without our founders “Checks and Balances” is the craziest thing I can think of.

How often have we learned through history that the “Good can be the Ememy of the Best” , despite my deep concern about congress, I’ll final end with a Churchill quote ” Democrocy is a bad form of government, but all the others are so much worst”.

Let’s not destroy our constitution, let’s vote in members of congress who actually represent the majority of the citizens in our country, so I guess my real message is to get out and vote, else as then say – if you don’t you deserve the government you got.

Dr. Magee, you provide a great public service. May I suggest you run for office, because I can tell who you are looking out for. I was not long ago a member of the “working poor” working full time and my employer didn’t provide health care, a major retail organization. So God Bless You.

Perry Boggia
Mike Magee
April 2nd, 2012 @ 11:59 am

Jack-

Thanks for the thoughtful comment. Thoughts on options now to the status quo – which I agree is messy?

Mike
Mike Magee
April 2nd, 2012 @ 12:24 pm

Perry-

Thanks so much for sharing your thoughts and analysis of this very critical issue. You are right that there is a great deal at stake here – short term and long term.

At the end of the day, I believe we’ve backed ourselves into a very difficult spot because we (all sectors tied to health care – organized medicine, the hospital industry, insurance, pharmaceuticals, medical liability lawyers and more – have been unable to muster the political will to continuously evolve, adjust and improve our approach incrementally to health delivery. Three decades later, the forces of change have created an extraordinarily steep hill to climb. But it’s not going to get any easier.

What we have before us is a complex and unusual compromise designed to break through the status-quo. If it is rejected (and if you are correct that the individual mandate over reaches, upsets the balance of power, and distorts our Constitution) then we have avoided creating a long term liability for our nation. That leaves us with our current problem – a highly variable, remarkably inaccessible and uneven delivery system in a nation that abhors “homelessness” but is quite comfortable with widespread “healthlessness”. What shall we do about that?

Mike